Supplemental Perioperative Oxygen (80% FIO₂) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

Abstract

Objective. Cesarean section can be a lifesaving procedure. However, as with many surgeries, it is not exempt of complications. Surgical site infections generate higher costs, serious morbidity, and mortality. This study evaluates the benefits of perioperative oxygen to prevent surgical site infections. Methods. We conducted a randomized controlled trial to assess the effects of perioperative oxygen to prevent surgical site infection after emergency cesarean section. Patients were randomized to receive either oxygen (80% FIO 2 ) during cesarean section plus two hours postsurgery or no supplemental oxygen. A sample of 326 patients was calculated for the primary outcome (163 in each group) and they were evaluated daily before leaving the hospital, at days 15 and 30. Results. Initially, 360 patients were enrolled, from which 17 were excluded (sample size: 343 (179 patients in the air group and 164 in the oxygen group)). We found no significant difference in the incidence of surgical site infection between these two groups at any of the evaluation times. Conclusion. In this study of patients with emergency cesarean section, we showed that the use of supplemental oxygen does not reduce the incidence of surgical site infection. This trial is registeres with ClinicalTrials.gov NCT01340534.

Effects of intraoperative high versus low inspiratory oxygen fraction (FiO2) on patient's outcome: A systematic review of evidence from the last 20 years

“…Considering patients operated under loco-regional anaesthesia, the results are more homogenous as the 6 available studies included caesarean sections and did not report any difference in the incidence of SSI between the high and low FiO2 groups. This is confirmed in the meta-analysis by de Jonge et al [91] that included 5 of the 6 studies we identified in this review with the exception of Admadé's study [70]. Thus, routine administration of supplemental oxygen to patients having caesarean section under epidural or spinal anaesthesia could be strongly questioned, considering that it does not appear to impact neither maternal nor foetal prognosis [94].…”

“…Six RCTs compared the incidence of SSI when administrating high or low FIO2 during caesarean section. Three studies had used different oxygen delivery devices between the high (concentration mask) and low (nasal cannula) FiO2 groups [69][70][71]. Only 2 studies specified the timing of antibiotic prophylaxis (at the time of cord clamping) [72,73].…”

Updated meta-analysis on intraoperative inspired fraction of oxygen and the risk of surgical site infection in adults undergoing general and regional anesthesia

“…Eventually, 30 randomized studies were included in this meta-analysis for a total of 18,055 patients, among which 24 compared high vs. low intraoperative FiO 2 during general anesthesia (n = 15,871 patients) 19 – 42 and 6 during regional anesthesia (n = 2184 patients) 43 – 48 . High FiO 2 was 80% in all studies except in Park’s study (FiO 2 60%) 37 ; and low FiO 2 was 30% in all studies except in Lin’s study (FiO 2 40%) 38 , Pryor’s and Park’s studies (FiO 2 35%) 20 , 37 , Mayank’s study (FiO 2 33%) 33 , and Admadé’s study (room air) 45 .…”

“…SSI were diagnosed using the CDC definition 21 , 24 , 26 – 29 , 31 – 33 , 35 , 36 , 39 , 41 , 42 , 46 , 47 , ASEPSIS definition 25 , 30 , 34 , 48 , or other trial-specific definitions 19 , 20 , 22 , 23 , 37 , 38 , 40 , 43 – 45 , in respectively 16, 4 and 10 out of the 30 included studies. Confounding factors influencing the incidence of SSI were variously considered.…”

“…(for patients under general anesthesia) 31 and Admadé et al . (for patients under general anesthesia) 45 , yet published within their inclusion period in 2017 and 2013 respectively. Finally, we believe that Kurz’s controlled cluster trial should have been included as this design comprised protections against biases very close to studies randomized at patient’s level, and provided data based on by far the largest sample of patients.…”